One of the most intimidating and challenging work in medical billing is estimating and collecting patient’s responsibility. Not only do you need to ensure your patient’s satisfaction to guarantee repeat visits and positive practice online reviews, but you must also collect money from your patients directly. Patients who have an exact idea of how much they owe are more likely to pay. It eventually increases practice collections and improves practice revenues ultimately.
“According to Finance System, Inc,
The number of patients failing to pay off their medical bill balances fully is expected to reach 95% by 2020.”
Similarly, research shows that, before a provider visit, 92% of patients want to know their payment responsibility. It is really important to your clinic’s financial health that you make it clear about the patient’s responsibility as daily payment plans of high-deductible are growing. Also, as the out-of-pocket patient’s responsibility is at an all-time high, collecting on patients at the time of service is crucial.
So far, small practices have no such patient responsibility estimation tool. Therefore estimating a patient’s responsibility before claims settlement is tough. However, small practices can successfully estimate patient responsibility to minimize potential payment risks and improve the critical tasks effectively, eventually elevating patient collections.
What Is Patient Responsibility
Patient responsibility in medical billing can be defined as the total payment amount a patient owes to the healthcare provider against the services. It’s the slice of a medical bill a patient has to pay out of pocket rather than their insurer. Patients with no health plan are responsible for fully paying their medical bills. Those with a High-deductible health plan (HDHP) are obligated to pay their medical bills until their deductible is covered, which is often higher on average.
Mostly, patients choose a High-deductible health plan (HDHP) with the perspective they will not need medical care that specific year. And in the end, they are likely to visit their provider more than they anticipate, which eventually leads to more medical expenses than expected.
Estimating Or Calculating Patient Responsibility
As patient responsibility for payment depends on payer contracts, state laws, and provider networks, most practices avoid calculating or estimating the patient’s responsibility. One reason is that there is not as such patient responsibility estimator thing exists. Secondly, it is also because they really don’t know if they are allowed to collect the amount at the time of service provision.
But patients covered by High Deductible Health Plans (HDHP) may pay the service provider at the time of service according to the estimated patient responsibility. However, this must be included in the claim when it is submitted. Also, one should make sure of patient responsibility for non-covered services. A service provider should make sure to process any refunds for overpayments if identified.
Collecting Payments Of Patient Responsibility Portion
The best way to collect the patient responsibility payment is through a credit card put on file with authorization and automatically charges up to an estimated amount immediately after settlement.
Including it in a financial and payment policy and patient responsibility payment form to collect a certain percentage of the estimated amount at the service provision is beneficial.
“Some numbers show that practices only collect 50% (sometimes less) of patient responsibility after patients leave your office.”
So, if a practice collects patient responsibility for more than 50% at the time of service, it improves the practice collections rate.
Medical Billing and Coding
Medical billing and coding are incomplete without patient responsibility understanding. So it’s better to have a proper insight into all things related to patient financial responsibility to improve practice collections.
GreenSense Billing is one of the emerging companies catering to medical practices and healthcare facilities. Our Medical Billers and Coders team is proficient enough to handle services ranging from RCM and PMS solutions. Our primary goal is to assist physicians and doctors looking to outsource billing and coding tasks to ease off some clinics’ administrative burden. Contact us today for further queries.
